Q: How can our team prepare for potential productivity losses post-ICD-10 implementation, specifically regarding procedure codes? Should we consider hiring additional staff or staff with a surgical background?
The updated guidelines in ICD-10-CM will impact how coders report certain diagnoses. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, highlights important changes in each section for coders to review before implementation.
Sue Bowman, MJ, RHIA, CCS, FAHIMA, and Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, provide strategies for coders and coding department managers to speak with physicians regarding ICD-10 in order to allay physicians’ fears.
A Recovery Auditor review of claims from September 25, 2012, to August 30, 2013, found providers billing hydration therapy with diagnosis codes not considered reasonable and medically necessary, according to the July 2015 Medicare Quarterly Compliance Newsletter .
Q: I have been told by our billers that infusion codes reported in the ED along with an E/M code that has modifier -25 (significant, separately identifiable evaluation and management service on the same day of the procedure or other service) require another modifier. I thought that -25 is the only modifier that should be submitted, unless the provider started a second infusion at a second site on the body. This is the first time I’ve been told the infusion coder need a modifier if the E/M has modifier -25 appended. All of my educational articles tell me that the two can be reported together. Have I missed an update somewhere along the way?
Combination codes in ICD-10-CM will allow coders to report pressure ulcer location and severity in a single code. Jaci Johnson Kipreos, CPC, CPMA, CEMC, COC, CPC-I, and Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD, review the stages of pressure ulcers and which information coders will have to look for in documentation.
ICD-10-CM seventh characters can be used to report more than just the episode of care. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, explains different seventh character uses and when to report them.
CMS has released a transcript and recording of its August 27 MLN Connects Call featuring ICD-10 coding guidance and the results of CMS’ final round of end-to-end testing.
Q: In my facility, we are supposed to send an email to our physician advisor (PA) and to administration if a query is not answered within a week. However, this policy doesn’t work well because administration does not do anything with that information, and the PA doesn’t have time to review unanswered queries. Do you have any suggestions concerning when to let a query go unanswered?
The 2016 IPPS final rule continues CMS’ plan to shift Medicare payments from volume to quality. Shannon Newell, RHIA, CCS, and James S. Kennedy, MD, CCS, CDIP, analyze the rule and the impact it could have on providers.
Six ICD-10-PCS root operations require a device, including Revision, Replacement, and Removal. Gretchen Young-Charles, RHIA, and Anita Rapier, RHIT, CCS, review how to differentiate these root operations and report associated devices.
OPPS costs rose approximately $1 billion more than expected in 2014 due to a CMS overestimation of the impact of laboratory packaging changes, according to the 2016 OPPS proposed rule. As a result, CMS proposes a 2% reduction to the 2016 conversion factor. CMS also proposes to expand laboratory packaging from date of service to the claim level.
The 2016 OPPS proposed rule released July 2 is deceptively short, but packs a punch. CMS is proposing the most massive APC reconfiguration and consolidation of APC groups since the beginning of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting, based in Washington, D.C., and Spicer, Minnesota.
ICD-10 implementation will arrive very soon, and many facilities are putting the final touches on their preparations. In the rush to complete coding education, documentation improvement, and system updates, HIM managers may not have looked at looming MS-DRG shifts.
In this month's issue, we review the quality and coding changes finalized in the 2016 IPPS final rule and explain how to identify MS-DRG shifts in ICD-10-PCS. Robert S. Gold discusses sequencing viral gastroenteritis, coding past medical conditions, and reporting neonatal codes
Robert S. Gold, MD, discusses educational opportunities for sequencing viral gastroenteritis, coding past medical conditions, and reporting neonatal codes.
